AnA1CM? and P?SCLCC?

Cf the SkLLL1AL SS1LM

8one |s composed of ce||s prote|n matr|x and m|nera| depos|ts
Lhe cells are of Lhree baslc Lypes
O CsLeoblasL
O CsLeocyLes
O CsLeoclasL
luncLlons of 8ones
W SupporL
W roLecLlon
W MovemenL
W Mlneral sLorage
W 8lood cell formaLlon
W ConLrlbuLes Lo body shape and form
8ones are classlfled by Lhelr shape
Lwo baslc Lypes of osseous Llssue
compacL or dense
cancellous or spongy
CompacL or dense
looks smooLh and homogeneous
Cancellous or spongy
ls composed of small needle llke or flaL pleces of bone called Lrabeculae and has
a good deal of open space
Lhe Lrabeculae form a neLwork and Lhe spaces beLween Lhe Lrabeculae are fllled
wlLh red or yellow bone marrow
|ass|f|cat|on of 8ones
Long bones
long bones are conslderably longer Lhan Lhey are wlde
lL ls consLrucLed prlmarlly of compacL bone buL may conLaln subsLanLlal
amounLs of spongy bone ln lLs lnLerlor
Are deslgned for welghL bearlng and movemenL
2 ShorL bones
Are roughly cube llke
1hey conLaln mosLly spongy bone compacL bone provldes [usL Lhelr Lhln surface layer
1he sesamold bones are a speclal Lype of shorL bone embedded wlLhln a Lendon (ex
aLella or knee cap)
3 llaL 8ones
Are Lhln flaLLened and unusually a blL curved
1hey have Lwo roughly parallel compacL bone surfaces wlLh a layer of spongy bone
beLween
Are lmporLanL slLes for hemaLopolesls and frequenLly provlde vlLal organ proLecLlon
4 rregular 8ones
all of Lhese bones have compllcaLed shapes and conslsLs malnly of spongy bone
enclosed by Lhln layers of compacL bone

erlosLeum
O a dense flbrous membrane LhaL covers Lhe bone
O lL nourlshes Lhe bone and allows for lLs growLh lL also provldes aLLachmenL of Lendons
and llgamenLs
O ConLalns nerves blood vessels and lymphaLlcs
O Lhe layer closesL Lo Lhe blne conLalns osLeoblasLs w/c are bone formlng cells
LndosLeum
O s a th|n vascu|ar membrane that covers the marrow cav|ty of |ong bones and
cance||ous bone
O CsLeoclasLs whlch dlssolve bone Lo malnLaln Lhe marrow cavlLy are locaLed nera Lhe
endosLeum ln Powshlp's lacunae
8one Marrow
O s a vascular Llssue locaLed ln Lhe medullary (shafL) cavlLy of long bones and ln flaL
bones
O ed bone marrow ls locaLed malnly ln Lhe sLernum lleum verLebrae and rlbs ln
adulLs and ls responslble for produclng red and whlLe blood cells
O
8one lormaLlon (osLeogenesls)
O CsslflcaLlon ls Lhe process by whlch Lhe bone maLrlx (collagen flbers and ground
subsLance) ls formed and hardenlng mlnerals are deposlLed on Lhe collagen flbers
O 1he collagen flbers glve Lenslle sLrengLh Lo Lhe bone and Lhe calclum provldes
compresslonal sLrengLh
1wo baslc process of osslflcaLlon
Lndochondral
2 nLramembranous

8one MalnLenance
1he lmporLanL regulaLlng facLors LhaL deLermlne Lhe balance beLween bone formaLlon and
bone resopLlon lnclude Lhe ff
Local sLress
IlLamln u
araLhyrold hormone and CalclLonln
8lood supply
8one Peallng
lracLure heallng occurs ln four areas
W 8one marrow
W 8one corLex
W erlosLeum
W LxLernal sofL Llssue
Slx sLages of fracLure heallng
W Accordlng Lo 8uckwaLer (2000)
PemaLoma and lnflammaLlon
2 Anglogenesls and carLllage formaLlon
3 CarLllage calclflcaLlon
4 CarLllage removal
3 8one formaLlon
6 emodellng

1he ArLlcular sysLem
Lhe [uncLlon of Lwo bones ls called a [olnL (arLlculaLlon)
1here are Lhree baslc klnds of [olnLs
W SynarLhrosls
W AmphlarLhrosls
W ularLhrosls
Several Lypes of dlarLhrosls [olnLs
W 8allandsockeL [olnLs
W Plnge [olnLs
W Saddle [olnLs
W lvoL [olnLs
O Clldlng [olnLs
r o|nt capsu|e
a Lough flbrous sheaLh LhaL surround Lhe arLlculaLlng bones
Lhe synovlum llnes Lhe capsule whlch secreLes Lhe lubrlcaLlng and shockabsorblng
synovlal fluld lnLlo Lhe [olnL capsule
r LlgamenLs
llbrous connecLlve Llssue bands LhaL blnd Lhe arLlculaLlng bones LogeLher
r 8ursa
s a sac fllled synovlal fluld LhaL cushlons Lhe movemenL of Lendons llgamenLs and bones aL a
polnL of frlcLlon

nS1Ck
Structure and Iunct|on of the Ske|eta| Musc|e System
Muscles of Lhe body are composed of parallel groups of muscle cells(fasclcull) encased
of flbrous Llssue called fascla(eplmyslum) 1he more Lhe muscle cells lL conLalns Lhe more Lhe
movemenL would be preclse SkeleLal muscles are lnvolved ln body movemenL posLure and
heaLproducLlon funcLlons
Ske|eta| Musc|e contract|on
Lach muscle cell conLalns myoflbrlls whlch conLalns sarcomeres and Lhese sarcomeres
conLaln Lhlck myosln and Lhln acLln fllamenLs Sarcomeres are Lhe acLual conLracLlle unlLs of
skeleLal muscle cells
Muscle cells conLracL ln response Lo elecLrlcal sLlmulaLlon dellvered by an effecLor nerve
cell aL Lhe moLor end plaLe 1hese muscle cells Lhen depolarlzes and generaLes an acLlon
poLenLlal 1hese Lhen propagaLe along Lhe muscle cell membrane and lead Lo Lhe release of
calclum lons LhaL are sLored ln Lhe sarcoplasmlc reLlcula An lncrease ln calclum lons wlll lead Lo
lnLeracLlon of Lhe acLln and myosln LhaL wlll lead Lo conLracLlon of muscles Lnergy ls used ln
conLracLlon and relaxaLlon 1he source of energy ls Lhe Lhe adenoslne LrlphosphaLe(A1) whlch
s generaLed Lhrough cellular oxldaLlve meLabollsm uurlng low levels of acLlvlLy Lhe skeleLal
muscles Lhen synLheslzes A1 from Lhe oxldaLlon of glucose Lo waLer and carbon dloxlde
uurlng sLrenuous acLlvlLy when oxygen ls noL LoLally avallable glucose ls meLabollzed prlmarlly
Lo lacLlc acld SLored muscle glycogen ls used Lo supply glucose durlng perlods of acLlvlLy
uurlng muscle conLracLlon noL all of Lhe energy ls consumed ln every acLlvlLy some are
used ln heaL form uurlng lsomeLrlc conLracLlon almosL all of Lhe energy ls released ln Lhe form
of heaL n Lhls conLracLlon Lhe lengLh of Lhe muscle remalns consLanL buL Lhe force generaLed ls
lncreased Whlle durlng lsoLonlc conLracLlon some of Lhe energy ls expended ln mechanlcal
work and Lhls conLracLlon ls characLerlzed by shorLenlng of Lhe muscles wlLh no lncrease ln Lhe
muscle Lenslon
Myoglobulln ls a hemogloblnllke proLeln plgmenL presenL ln sLrlaLed muscle cells LhaL
LransporL oxygen Muscles conLalnlng llLLle myoglobulln(whlLe muscles) conLracLs fasLer whlle
muscles LhaL conLalns many of Lhese myoglobulln(red muscles) conLracLs slowly buL powerfully
Musc|e tone
Muscle Lone ls produced by Lhe malnLenance of some of Lhe muscle flbers ln conLracLed
sLaLe Muscle Lone ls mlnlmal durlng sleep and lncreased when Lense and anxlous A muscle
LhaL ls llmp and wlLhouL Lone ls descrlbed as flaccld Muscles wlLh greaLer Lhan normal Lone ls
descrlbed as spasLlc
Muscle acLlon
1he prlme mover ls Lhe muscle LhaL causes a parLlcular moLlon 1he muscle LhaL asslsLs
Lhe prlme mover are known as synerglsLs 1he muscle causlng movemenL opposlLe Lo LhaL of
Lhe prlme mover are called anLagonlsLs
Lxerc|se D|suse kepa|r
PyperLrophy ls Lhe resulL from an lncrease ln Lhe slze of lndlvldual muscle flbers wlLhouL
an lncrease ln Lhelr number PyperLrophy perslsLs only when exerclse ls conLlnued Age and
dlsuse cause loss of muscular funcLlon as flbroLlc Llssue replaces Lhe conLracLlle muscle Llssue
1he decrease ln slze of muscle ls called aLrophy When muscles are ln[ured Lhey need resL and
lmmoblllzaLlon unLll Llssue repalr occurs 1he healed muscles Lhen needs progresslve exerclse
Lo resume lLs preln[ury sLrengLh and funcLlonal ablllLy
ASSLSSMLN1
nea|th n|story
ommon Symptoms
paln Lenderness LlghLness and abnormal sensaLlons
a|n
When paln ls noL relleved by lmmoblllzaLlon lL would be because of lnfecLlon or
severe compllcaLlons 1he nurse should assess for body allgnmenL pressure from
LracLlon and Lenslon on skln
W 8one paln dull deep ache and borlng
W Muscular paln soreness or achlng muscle cramps
W lracLure paln sharp and plerclng relleved by lmmoblllzaLlon
W Sharp paln due Lo bone lnfecLlon wlLh muscle spasm or pressure on sensory nerve
A|tered sensat|on
1he paLlenL may descrlbe paresLheslas whlch are burnlng Llngllng sensaLlons or
numbness 1hese may be caused by pressure on nerves or by clrculaLlon lmpalrmenL
SofL Llssue swelllng or dlrecL Lrauma Lo Lhese sLrucLures can lmpalr Lhelr funcLlon
ast hea|th Soc|a| and Iam||y n|story
CccupaLlon( uoes Lhe paLlenL's work requlre physlcal acLlvlLy or heavy llfLlng?)
exerclse paLLerns dleLary lnLake(calclum and vlLamln u) and concurrenL healLh
condlLlons(uM hearL dlsease CCu lnfecLlon arLhrlLls)

nSAL ASSLSSMLN1 CI 1nL MUSULCSkLLL1AL IUN1CN
hys|ca| Assessment
O 1he exLenL of assessmenL depends on Lhe paLlenL's physlcal complalnLs healLh hlsLory
and physlcal clues LhaL warranL furLher exploraLlon
O 1he assessmenL ls focuslng on Lhe paLlenL's ablllLy Lo perform acLlvlLles of dally llvlng
O 1echnlques used LhaL are common lnspecLlon and palpaLlon
Assess|ng the osture
O 1he normal curvaLure of Lhe splne ls convex Lhrough Lhe Lhoraclc porLlon and concave
Lhrough Lhe cervlcal and lumbar porLlons
O Common ueformlLles
kyphosls an lncreased forward curvaLure of Lhe Lhoraclc splne
Lordosls or sway back an exaggeraLed curvaLure of Lhe lumbar splne
Scollosls a laLeral curvlng devlaLlon of Lhe splne
O uurlng lnspecLlon of Lhe splne Lhe enLlre back buLLocks and legs are exposed
O 1he examlner lnspecLs Lhe splnal curves and Lrunk symmeLry from posLerlor and laLeral
vlews
O 1he gluLeal folds are normally symmeLrlcal
O Shoulder and hlp symmeLry as well as Lhe llne of Lhe verLebral column are lnspecLed
wlLh Lhe paLlenL erecL and wlLh Lhe paLlenL bendlng forward
Assess|ng the Ga|t
O L ls assessed by havlng Lhe paLlenL walk away from Lhe examlner for a shorL dlsLance
O SmooLhness and rhyLhm ls observed
O Llmplng moLlon ls noLed lf lL ls caused by a palnful welghL bearlng
O LlmlLed [olnL moLlon also affecLs galL
Assess|ng the 8one ntegr|ty
O 8ones are assessed for deformlLles and allgnmenL
O SymmeLry of Lhe body parLs are also assessed
O ShorLened exLremlLles bone Lumors ampuLaLlons and fracLures are also noLed
O MovemenL of fracLured parL should be mlnlmlzed Lo avold furLher ln[ury
Assess|ng the o|nt Iunct|on
O 1he arLlcular sysLem ls evaluaLed by noLlng range of moLlon deformlLy sLablllLy and
nodular formaLlon
O CM ls evaluaLed boLh acLlvely and passlvely
O reclse measuremenL of CM ls done by a gon|ometer ( a proLracLor deslgned for
evaluaLlng [olnL moLlon)
O LlmlLed CM can be caused by
SkeleLal deformlLy
!olnL paLhology
ConLracLure ( shorLenlng of surroundlng [olnL sLrucLures)
O f [olnL moLlon ls compromlsed or [olnL ls palnful Lhe [olnL ls examlned for effus|on(
excesslve fluld wlLhln Lhe capsule) swelllng and lncreased ln LemperaLure LhaL maL
reflecL acLlve lnflammaLlon
O L can be assessed by ldenLlfylng for Lhe balloon slgn and for Lhe balloLLemenL of Lhe
knee
O !olnL deformlLy may also be caused by
ConLracLure
ulslocaLlon
SubluxaLlon (parLlal separaLlon of arLlcular surface)
ulsrupLlon of sLrucLures surroundlng Lhe [olnL
O alpaLlon of Lhe [olnL whlle lL ls passlvely moved provldes lnformaLlon abouL Lhe
lnLegrlLy of Lhe [olnL
O normally [olnL moves smooLhly
O 1he Llssue surroundlng Lhe [olnL ls examlned for nodule formaLlon
O Slze of Lhe [olnL ls ofLen exaggeraLed by aLrophy of Lhe muscles proxlmal and dlsLal Lo
LhaL [olnL 1hls ls common ln rheumaLold arLhrlLls of Lhe knees
Musc|e Strength and S|ze
O Weakness of Lhe group may lndlcaLe varleLy of condlLlons such as
W olyneuropaLhy
W LlecLrolyLe lmbalance (parLlcularly poLasslum and calclum)
W MyasLhenla gravls
W ollomyellLls
W Muscular dysLrophy
O 1he nurse can deLermlne Lhe muscle Lone by palpaLlng Lhe muscle whlle passlvely
movlng Lhe relaxed exLremlLy
O 1he nurse assesses muscle sLrengLh by havlng Lhe paLlenL perform cerLaln maneuvers
wlLh and wlLhouL added reslsLance
O 1he nurse may ellclL muscle c|onus (rhyLhmlc conLracLlon of a muscle)
O Iasc|cu|at|on (lnvolunLary LwlLchlng of muscle flber groups) may be observed
O 1o monlLor lncreased slze due Lo exerclse edema or bleedlng lnLo Lhe muscle Lhe
nurse measures Lhe glrLh of an exLremlLy
O 1he unaffecLed exLremlLy ls measured and used as Lhe reference sLandard for Lhe
affecLed exLremlLy
O L ls lmporLanL LhaL Lhe measuremenLs be Laken aL Lhe same locaLlon on Lhe exLremlLy
and wlLh Lhe exLremlLy ln Lhe same poslLlon wlLh Lhe muscle aL resL
O MeasuremenLs are Laken aL Lhe maxlmum clrcumference of Lhe exLremlLy
W lor ease of serlal assessmenL Lhe nurse may lndlcaLe Lhe polnL of measuremenL
by marklng Lhe skln
W IarlaLlons ln slze greaLer Lhan cm are consldered slgnlflcanL
Sk|n
O nurse lnspecLs Lhe skln for
Ldema
1emperaLure
Color
O alpaLlon can reveal wheLher any areas are
Warmer
SuggesLlng lncreased Llssue perfuslon or lnflammaLlon
SuggesLlng decreased Llssue perfuslon
Ldema presenL
O CuLs brulses skln color and lnflammaLlon can lnfluence nurslng managemenL of
musculoskeleLal condlLlons



Neurovascu|ar Status
O Cne of Lhe compllcaLlons LhaL needs Lo be assessed ls Lhe comparLmenL syndrome
(when Lhere ls lncreased Llssue perfuslon wlLhln a llmlLed space LhaL compromlses Lhe
clrculaLlon and Lhe funcLlon of Lhe Llssue wlLhln Lhe conflned area
Nerve 1est of sensat|on 1est of movement
eroneal nerve rlck Lhe skln mldway
beLween Lhe greaL and
second Loe
Ask Lhe paLlenL Lo dorslflex
Lhe fooL and exLend Lhe Loes
1lblal nerve rlck Lhe medlal and laLeral
surface of Lhe sole
Ask Lhe paLlenL Lo planLar
flex Loes and fooL
adlal nerve rlck Lhe skln mldway
beLween Lhe Lhumb and
second flnger
Ask Lhe paLlenL Lo sLreLch ouL
Lhe Lhumb Lhen Lhe wrlsL
and Lhen Lhe flngers aL Lhe
meLacarpal [olnLs
ulnar nerve rlck Lhe dlsLal faL pad of Lhe
small flnger
Ask Lhe paLlenL Lo abducL all
flngers
Medlan nerve rlck Lhe Lop or dlsLal surface
of Lhe lndex flnger
Ask Lhe paLlenL Lo Louch Lhe
Lhumb Lo Lhe llLLle flnger
Also observe wheLher Lhe
paLlenL can flex Lhe wrlsL




nd|cators of er|phera| Neurovascu|ar Dysfunct|on
ClrculaLlon
Color pale cyanoLlc or moLLled
1emperaLure cool
Caplllary reflll more Lhan 3 seconds
2 MoLlon
Weakness
aralysls
3 SensaLlon
aresLhesla
unreLenLlng paln
aln on passlve sLreLch
Absence of feellng

I D|agnost|c Lva|uat|on
mag|ng rocedures
O Oray stud|es

Orays are a form of lonlzlng radlLlon LhaL can peneLraLe Lhe body Lo form an lmage on fllm O
ray sLudles are lmporLanL ln evaluaLlng paLlenLs wlLh musculoskeleLal dlsorders 8one xrays
deLermlne bone denslLy LexLure eroslon and changes ln bone relaLlonshlps MulLlple xrays
are needed for full assessmenL of Lhe sLrucLure belng examlned Oray sLudy of Lhe corLex of Lhe
bone reveals any wldenlng narrowlng or slgns of lrregularlLy !olnL xrays reveal fluld
lrregularlLy spur formaLlon narrowlng and changes ln Lhe [olnL sLrucLure AfLer belng
poslLloned for Lhe sLudy Lhe paLlenL musL remaln sLlll whlle Lhe xrays are Laken

Spur splked pro[ecLlng body

O omputed tomography

A compuLed Lomography (C1) scan shows ln deLall a speclflc plane of lnvolved bone and can
reveal Lumors of Lhe sofL Llssue or ln[urles Lo Lhe llgamenLs or Lendons L ls used Lo ldenLlfy Lhe
locaLlon and exLenL of fracLures ln areas LhaL are dlfflculL Lo evaluaLe (eg aceLabulum) C1
sLudles lasL abouL hour 1he paLlenL musL remaln sLlll durlng Lhe procedure

O Magnet|c kesonance mag|ng

MagneLlc resonance lmaglng (M) ls a nonlnvaslve lmaglng Lechnlque LhaL uses magneLlc
flelds radlo waves and compuLers Lo demonsLraLe abnormallLles (le Lumors or narrowlng of
Llssue paLhways Lhrough bone) of sofL Llssues such as muscle Lendon carLllage nerve and faL
8ecause an elecLromagneL ls used paLlenLs wlLh any meLal lmplanLs cllps or pacemakers are
noL candldaLes for M

1o enhance vlsuallzaLlon of anaLomlc sLrucLures conLrasL medla may be ln[ecLed lnLravenously
uurlng Lhe procedure Lhe paLlenL needs Lo lle sLlll for Lo 2 hours and wlll hear a rhyLhmlc
knocklng sound aLlenLs who experlence clausLrophobla may be unable Lo LoleraLe Lhe
conflnemenL of closed M equlpmenL wlLhouL sedaLlon Cpen M sysLems are avallable buL
Lhey use lowerlnLenslLy magneLlc flelds whlch reduces Lhe quallLy of Lhe lmaglng repeaLed
lmaglng may be requlred AdvanLages of open M lnclude lncreased paLlenL comforL reduced
problems wlLh clausLrophoblc paLlenLs and reduced nolse

O Arthrography

ArLhrography ls a Lype of xray examlnaLlon LhaL uses a conLrasL agenL Lo lmage an anaLomlcal
[olnL such as Lhe knee shoulder elbow or wrlsL An arLhrogram demonsLraLes Lhe sLrucLures
of Lhe [olnL lncludlng carLllage llgamenLs and bursa (Lhe fluldfllled [olnL capsule)

ArLhrography ls useful ln ldenLlfylng acuLe or chronlc Lears of Lhe [olnL capsule or supporLlng
llgamenLs of Lhe knee shoulder ankle hlp or wrlsL A radlopaque subsLance or alr ls ln[ecLed
lnLo Lhe [olnL cavlLy Lo ouLllne sofL Llssue sLrucLures and Lhe conLour of Lhe [olnL 1he [olnL ls puL
Lhrough lLs range of moLlon Lo dlsLrlbuLe Lhe conLrasL agenL whlle a serles of xrays ls obLalned
f a Lear ls presenL Lhe conLrasL agenL leaks ouL of Lhe [olnL and ls evldenL on Lhe xray lmage

AfLer an arLhrogram Lhe [olnL ls usually resLed for 2 hours and a compresslon elasLlc bandage
ls applled as prescrlbed n addlLlon Lhe nurse provldes comforL measures (mlld analgesla lce)
as approprlaLe 1he nurse should explaln Lo Lhe paLlenL LhaL lL ls normal Lo experlence cllcklng
or crackllng ln Lhe [olnL for a day or Lwo afLer Lhe procedure unLll Lhe conLrasL agenL or alr ls
absorbed

Nurs|ng ntervent|ons for mag|ng rocedures

8efore Lhe paLlenL undergoes an lmaglng sLudy Lhe nurse should assess for condlLlons LhaL may
requlre speclal conslderaLlon durlng Lhe sLudy or LhaL may be conLralndlcaLlons Lo Lhe sLudy
(eg pregnancy clausLrophobla lnablllLy Lo LoleraLe requlred poslLlonlng due Lo age deblllLy or
dlsablllLy meLal lmplanLs) L ls essenLlal LhaL Lhe paLlenL remove all [ewelry halr cllps hearlng
alds and oLher meLal before havlng an M f conLrasL agenLs wlll be used for C1 scan M or
arLhrography Lhe nurse should carefully assess Lhe paLlenL for posslble allergy

8CNL DLNS1CML1k

8one denslLomeLry ls used Lo esLlmaLe bone mlneral denslLy (8Mu) 1hls can be done Lhrough
Lhe use of xrays or ulLrasound uualenergy xray absorpLlomeLry (uLOA) deLermlnes bone
mlneral denslLy aL Lhe wrlsL hlp or splne Lo esLlmaLe Lhe exLenL of osLeoporosls and Lo monlLor
a paLlenL's response Lo LreaLmenL for osLeoporosls 8one sonomeLry (ulLrasound) measures
heel bone quanLlLy and quallLy and ls used Lo esLlmaLe 8Mu and Lhe rlsk of fracLure for people
wlLh osLeoporosls 8one denslLy sonography ls a cosL effecLlve readlly avallable screenlng Lool
for dlagnoslng osLeoporosls and predlcLlng a person's rlsk for fracLure

8one denslLomeLry checks an area of Lhe body such as Lhe hlp hand or fooL for slgns of mlneral
loss and bone Lhlnnlng

n Lhe pasL osLeoporosls could only be deLecLed afLer you broke a bone 8y LhaL Llme however
your bones could be qulLe weak A bone denslLy LesL makes lL posslble Lo know your rlsk of
breaklng bones before Lhe facL
A bone denslLy LesL uses Orays Lo measure how many grams of calclum and oLher bone
mlnerals are packed lnLo a segmenL of bone A bone denslLy LesL ls a falrly accuraLe predlcLor of
your rlsk of fracLure
8CNL SAN
A bone scan ls a nuclear scannlng LesL LhaL ldenLlfles new areas of bone growLh or breakdown
L can be done Lo evaluaLe damage Lo Lhe bones flnd cancer LhaL has spread (meLasLaslzed) Lo
Lhe bones and monlLor condlLlons LhaL can affecL Lhe bones (lncludlng lnfecLlon and Lrauma) A
bone scan can ofLen flnd a problem days Lo monLhs earller Lhan a regular Oray LesL
lor a bone scan a radloacLlve Lracer subsLance ls ln[ecLed lnLo a veln ln Lhe arm 1he Lracer
Lhen Lravels Lhrough Lhe bloodsLream and lnLo Lhe bones 1hls process may Lake several hours
A speclal camera (gamma) Lakes plcLures of Lhe Lracer ln Lhe bones 1hls helps show cell acLlvlLy
and funcLlon ln Lhe bones Areas LhaL absorb llLLle or no amounL of Lracer appear as dark or
cold spoLs whlch may lndlcaLe a lack of blood supply Lo Lhe bone (bone lnfarcLlon) or Lhe
presence of cerLaln Lypes of cancer Areas of rapld bone growLh or repalr absorb lncreased
amounLs of Lhe Lracer and show up as brlghL or hoL spoLs ln Lhe plcLures PoL spoLs may
lndlcaLe problems such as arLhrlLls Lhe presence of a Lumor a fracLure or an lnfecLlon
A bone scan may be done on Lhe enLlre body or [usL a parL of lL
A bone scan ls done Lo
O llnd bone cancer or deLermlne wheLher a cancer from anoLher area such as Lhe breasL lung
kldney Lhyrold gland or prosLaLe gland has spread (meLasLaslzed) Lo Lhe bone See a plcLure of
a bone scan showlng Lhe spread of cancer
O Pelp dlagnose Lhe cause or locaLlon of unexplalned bone paln such as ongolng low back paln A
bone scan may be done flrsL Lo help deLermlne Lhe locaLlon of an abnormal bone ln complex
bone sLrucLures such as Lhe fooL or splne lollowup evaluaLlon Lhen may be done wlLh
a compuLed Lomography (C1) scan ormagneLlc resonance lmaglng (M)
O Pelp dlagnose broken bones such as a hlp fracLure or a sLress fracLure noL clearly seen on O
ray
O llnd damage Lo Lhe bones caused by lnfecLlon or oLher condlLlons such asageLs dlsease
Ak1nkCSC
ArLhroscopy (also called arLhroscoplc surgery) ls a mlnlmally lnvaslve surglcal procedure ln
whlch an examlnaLlon and someLlmes LreaLmenL of damage of Lhe lnLerlor of a [olnL ls
performed uslng an arLhroscope a Lype of endoscope LhaL ls lnserLed lnLo Lhe [olnL Lhrough a
small lnclslon ArLhroscoplc procedures can be performed elLher Lo evaluaLe or Lo LreaL many
orLhopedlc condlLlons lncludlng Lorn floaLlng carLllage Lorn surface carLllage ACL
reconsLrucLlon and Lrlmmlng damaged carLllage
1he advanLage of arLhroscopy over LradlLlonal open surgery ls LhaL Lhe [olnL does noL have Lo be
opened up fully nsLead for knee arLhroscopy for example only Lwo small lnclslons are made
one for Lhe arLhroscope and one for Lhe surglcal lnsLrumenLs Lo be used ln Lhe knee cavlLy Lo
fully remove Lhe knee cap 1hls reducesrecovery Llme and may lncrease Lhe raLe of surglcal
success due Lo less Lrauma Lo Lhe connecLlve Llssue L ls especlally useful for professlonal
aLhleLes who frequenLly ln[ure knee [olnLs and requlre fasL heallng Llme 1here ls also less
scarrlng because of Lhe smaller lnclslons rrlgaLlon fluld ls used Lo dlsLend Lhe [olnL and make a
surglcal space SomeLlmes Lhls fluld leaks lnLo Lhe surroundlng sofL Llssue
causlng exLravasaLlon and edema
1he surglcal lnsLrumenLs used are smaller Lhan LradlLlonal lnsLrumenLs Surgeons vlew Lhe [olnL
area on a vldeo monlLor and can dlagnose and repalr Lorn [olnL Llssue such
as llgamenLs and menlscl or carLllage
L ls Lechnlcally posslble Lo do an arLhroscoplc examlnaLlon of almosL every [olnL ln Lhe human
body 1he [olnLs LhaL are mosL commonly examlned and LreaLed by arLhroscopy are Lhe knee
shoulder elbow wrlsL ankle fooL and hlp
I CS1LCCkCSS

What |s Csteoporos|s?

A condlLlon characLerlzed by a decrease ln Lhe denslLy of bone decreaslng lLs sLrengLh
and resulLlng ln fraglle bones CsLeoporosls llLerally leads Lo abnormally porous bone
LhaL ls compresslble llke a sponge 1hls dlsorder of Lhe skeleLon weakens Lhe bone and
resulLs ln frequenL fracLures ln Lhe bones
CsLeoporosls can be presenL wlLhouL any sympLoms for decades because osLeoporosls
doesnL cause sympLoms unLll bone fracLures

k|sk Iactors

Iema|e gender
Caucaslan or Aslan race
1hln and small body frame
lamlly hlsLory of osLeoporosls (for example havlng a moLher wlLh an osLeoporoLlc hlp
fracLure doubles your rlsk of hlp fracLure)
ersonal hlsLory of fracLure
Lack of exerclse
uleL low ln calclum
oor nuLrlLlon and poor general healLh
Low esLrogen levels ln women (such as occur ln menopause or wlLh early surglcal
removal of boLh ovarles)
Low LesLosLerone levels ln men (hypogonadlsm)
mmoblllLy such as afLer a sLroke or from any condlLlon LhaL lnLerferes wlLh walklng
When vlLamln u ls lacklng Lhe body cannoL absorb adequaLe amounLs of calclum from
Lhe dleL Lo prevenL osLeoporosls IlLamln u deflclency can resulL from lack of lnLesLlnal
absorpLlon of Lhe vlLamln such as occurs ln cellac sprue and prlmary blllary clrrhosls

What factors determ|ne bone strength?
8one mass (bone denslLy) ls deLermlned by Lhe amounL of bone presenL ln Lhe skeleLal
sLrucLure Cenerally Lhe hlgher Lhe bone denslLy Lhe sLronger Lhe bones 8one denslLy
ls greaLly lnfluenced by geneLlc facLors whlch ln Lurn are someLlmes modlfled by
envlronmenLal facLors and medlcaLlons lor example men have a hlgher bone denslLy
Lhan women and Afrlcan Amerlcans have a hlgher bone denslLy Lhan Caucaslan or Aslan
Amerlcans
normally bone denslLy accumulaLes durlng chlldhood and reaches a peak by around age
23 8one denslLy Lhen ls malnLalned for abouL 0 years AfLer age 33 boLh men and
women wlll normally lose 0303 of Lhelr bone denslLy per year as parL of Lhe aglng
process
LsLrogen ls lmporLanL ln malnLalnlng bone denslLy ln women When esLrogen levels drop
afLer menopause loss of bone denslLy acceleraLes uurlng Lhe flrsL flve Lo 0 years afLer
menopause women can suffer up Lo 24 loss of bone denslLy per year! 1hls can
resulL ln Lhe loss of up Lo 2330 of Lhelr bone denslLy durlng LhaL Llme perlod 1he
acceleraLed bone loss afLer menopause ls a ma[or cause of osLeoporosls ln women
referred Lo as posLmenopausal osLeoporosls

I lAC1uL
CompleLe lracLure enLlre clrcumference of Lhe bone ls lmpalred
ncompleLe lracLure lnvolves a break Lhrough only parL of Lhe crosssecLlon of Lhe bone
CommlnuLed lracLure bone has spllnLered lnLo several fragmenLs
Closed lracLure does noL cause a break ln Lhe skln
Cpen lracLure Lhe skln or mucous membrane wound exLends Lo Lhe fracLured bone
ulsplaced lracLure bone pleces are ouL of normal allgnmenL Cne or boLh pleces may be
ouL of allgnmenL
mpacLed lracLure a bone fragmenL ls drlven lnLo anoLher bone fragmenL
aLhologlc lracLure caused by bone's belng weakened elLher by pressure from a Lumor or
an acLual Lumor wlLhln Lhe bone
CreensLlck lracLure one slde of a bone ls broken and Lhe oLher slde ls benL
Llnear lracLure a fracLure LhaL exLends parallel Lo Lhe long axls of a bone buL does noL
dlsplace Lhe bone Llssue
Cbllque lracLure Lhe llne of break goes dlagonal along Lhe bone
LonglLudlnal lracLure occurs along Lhe lengLh of Lhe bone
1ransverse lracLure bone fracLured horlzonLally
Splral lracLure a fracLure LhaL LwlsLs around Lhe shafL of Lhe bone
SLellaLe a fracLure ln whlch Lhere are numerous flssures radlaLlng from Lhe cenLral polnL of
lmpacL or ln[ury LhroughouL surroundlng bone Llssue
Colles'lracLure dlsLal fracLure of Lhe radlus ln Lhe forearm wlLh dorsal (posLerlor)
dlsplacemenL of Lhe wrlsL
oLL's lracLure fracLure of Lhe lower parL of Lhe flbula wlLh serlous ln[ury of Lhe lower
Llblal arLlculaLlon usually a chlpplng off of a porLlon of Lhe medlal
malleolus or rupLure of Lhe medlal llgamenL
ArLlcular lracLure fracLure lnvolvlng Lhe [olnL surface of a bone
LxLracapsular lracLure any fracLure LhaL occurs near a [olnL buL does noL dlrecLly lnvolve
Lhe [olnL capsule
nLracapsular lracLure a fracLure wlLhln Lhe capsule of a [olnL
Lplphyseal lracLure a fracLure lnvolvlng Lhe eplphyseal plaLe of a long bone whlch causes
separaLlon or fragmenLaLlon of Lhe plaLe
AngulaLlon lracLure a fracLure ln whlch Lhe fragmenLs of bone are aL angles Lo one
anoLher
Avulslon lracLure a fracLure ln whlch a fragmenL of bone has been pulled away by a
Lendon and lLs aLLachmenL
8lowouL lracLure fracLure of Lhe orblLal floor caused by a sudden lncrease of lnLraorblLal
pressure due Lo LraumaLlc force
Compresslon lracLure bone has been compressed
laLlgue or March lracLure resulLs from excesslve physlcal acLlvlLy and noL from any
speclflc ln[ury















aLhophyslology
























redlsposlng lacLors
MoLor Iehlcle AccldenLs and lalls
reclplLaLlng lacLors
CsLeoporosls or meLasLaLlc bone cancer
lracLure occurs
ulrecL lorce
ndlrecL lorce
1he perlosLeum and blood vessel ln Lhe
corLex Marrow surroundlng sofL Llssues
are dlsrupLed
8leedlng occurs
PemaLoma lorms
Cllnlcal ManlfesLaLlon
ueformlLy
Swelllng
8rulslng
Muscle Spasm
1enderness
aln
mpalred SensaLlon
(numbness)
Loss of normal funcLlon
Abnormal moblllLy
CreplLus
Pypovolemlc Shock

8one Llssue lmmedlaLely ad[acenL Lo
fracLure dles
necroLlc Llssue sLlmulaLes an lnLense
lnflammaLory response

IasodllaLlon LxudaLlon of plasma
and leukocyLes
nfllLraLlon of oLher
W8C

8one Peallng
Larly CompllcaLlons
LongLerm CompllcaLlons
8CnL PLALnC
SLage onePemaLoma lormaLlon
WlLhln 24 hours Lhe blood cloL beglns Lo organlze As Lhe blood ln Lhe hemaLoma cloLs
(coagulaLes) a loose dellcaLe mesh of flbrln forms around Lhe fracLure slLe 1he flbrln mesh
proLecLlvely encloses Lhe damaged bone and acLs as a scaffold for Lhe lngrowLh of caplllary
buds and flbroblasLs new caplllarles sLarL Lo grow lnLo Lhe cloLLed hemaLoma AfLer 24 hours
Lhe maln blood supply lncreases Lo Lhe fracLured bone ends L undergoes changes and develops
lnLo granulaLlon Llssue
SLage LwoCellular rollferaLlon
1hls sLage Lakes place aL Lhe fracLured slLe where Lorn ends of perlosLeum endosLeum and
bone marrow supply Lhe cells LhaL prollferaLe and dlfferenLlaLe lnLo flbrocarLllage hyallne
carLllage and flbrous connecLlve Llssues
AfLer several days Lhe comblnaLlon of perlosLeal elevaLlon and Lhe granulaLlon Llssue forms a
collar around Lhe end of each fragmenL 1he collars evenLually advance unlLe and form a
brldge across Lhe fracLure slLe
SLage Lhreerocallus lormaLlon
Slx Lo Len days afLer ln[ury Lhe granulaLlon Llssue changes and a provlslonal callus forms newly
formed carLllage and bone maLrlx (derlved ln parL from Lhe undamaged perlosLeum and
endosLeum of ad[acenL bone marglns) dlsperse Lhrough Lhe sofL Llssue callus
n uncompllcaLed fracLure Lhe provlslonal callus usually reaches lLs maxlmal slze abouL 4 Lo 2
days afLer Lhe ln[ury 1hls mass ls subsequenLly remodeled
SLage fourCsslflcaLlon
A permanenL callus of Lrue rlgld bone evenLually forms by Lhe deposlLlon of calclum salLs
whlch knlLs Lhe fracLured bone ends LogeLher CsslflcaLlon flrsL forms an exLernal callus
(beLween Lhe perlosLeum and corLex) nexL an lnLernal callus (medullary plug) and flnally an
lnLermedlaLe callus (beLween Lhe corLlcal fragmenLs)
SLage llveConsodllaLlon and emodellng
8one remode||ng Lhe flnal phase of bone heallng goes on for several monLhs n remodellng
bone conLlnues Lo form and becomes compacL reLurnlng Lo lLs orlglnal shape n addlLlon
blood clrculaLlon ln Lhe area lmproves Cnce adequaLe bone heallng has occurred
welghLbearlng (such as sLandlng or walklng) encourages bone remodellng
nCnSuCCAL MAnACLMLn1
CLCSLu LuuC1Cn
L ls Lhe mosL common nonsurglcal meLhod for managlng a slmple fracLure Whlle applylng a
manual pull or LracLlon on Lhe bone Lhe healLh care provlder manlpulaLes Lhe ends so LhaL
Lhey reallgn
8AnuACLS Anu SLn1S
lor cerLaln areas of Lhe body such as scapula and clavlcle an elasLlc bandage or commerclal
moblllze may be used Lo lmmoblllze Lhe bone durlng heallng 8ecause upper exLremlLy welghL
spllnLs may be sufflclenL Lo keep bone fragmenLs ln place 1hermoplasL a durable flexlble
maLerlal for spllnLlng allows cusLom flLLlng Lo Lhe cllenL's parL
CAS1S
lor more complex fracLures or fracLures of Lhe lower exLremlLy Lhe physlclan or orLhopedlc
Lechnlclan applles casL Lo hold bone fragmenLs ln place afLer reducLlon
s a rlgld devlce LhaL lmmoblllzes Lhe affecLed body parL whlle allowlng oLher body parLs Lo
move
May be applled for correcLlon of deformlLles (such as clubfooL) or for prevenLlon of deformlLles
(such as Lhose seen ln some cllenLs wlLh rheumaLold arLhrlLls)
1?LS Cl CAS1S
1?L and CPAAC1LS1CS Cl CAS1 uSL
uL LO1LM1? CAS1S
ShorLarm CasL

Longarm CasL

Panglngarm casL



1humb splca
Shoulder Splca


SLable fracLures of Lhe wrlsL (meLacarpals
carpals or dlsLal radlus)
unsLable fracLures of Lhe wrlsL dlsLal
humerus radlus or ulna
lracLures of Lhe humerus LhaL cannoL be
allgned by LAC (llghL LracLlon ls posslble whlle
Lhe cllenL ls ln bed or by an aLLached sLrap LhaL
exLends around Lhe neck)
lracLures of Lhe Lhumb
unsLable fracLures of Lhe shoulder glrdle or
humerus dlslocaLlons of Lhe shoulder
LCWL LO1LM1? CAS1S
ShorLleg casL
Longleg casL

lracLures of Lhe ankle meLaLarsals or fooL
unsLable fracLures of Lhe Llbla flbula or ankle
Walklng casL
Leg Cyllnder
Longleg Cyllnder
Same as for SLC or LLC
SLable fracLures of Lhe Llbla flbula or knee
SLable fracLures of Lhe dlsLal femur proxlmal
Llbla or knee
CAS1 8ACLS
aLellar welghLbearlng casL
LxLernal polycenLrlc knee hlnge casL

MldshafL or dlsLal shafL fracLures of Lhe femur
Same as for Lhe paLellar welghLbearlng casL
8Cu? CAS1S
Plp splca
lsser's casL
Palo casL

ulslocaLlon of Lhe hlp pelvlc or hlp ln[urles
Scollosls Lhoraclc splnal fracLures
lracLures of Lhe cervlcal splne

CAS1 S?nuCML
Also called superlor mesenLerlc arLery syndrome" an uncommon buL serlous compllcaLlon ls
mosL ofLen seen ln orLhopedlc cllenLs who have been placed ln a hlp splca or body casL
arLlal or compleLe upper lnLesLlnal obsLrucLlon resulLs classlc sympLoms abdomlnal dlsLenLlon
eplgasLrlc paln nausea and vomlLlng
arLlal obsLrucLlon occurs lnlLlally from compresslon of Lhe Lhlrd porLlon of duodenum beLween
Lhe superlor mesenLerlc arLery and Lhe aorLa
CAS1 CAL
WlLh a plasLer casL lL ls parLlcularly lmporLanL Lo warn Lhe cllenL abouL Lhe heaL LhaL wlll be felL
lmmedlaLely afLer Lhe weL casL ls applled
When a cllenL wlLh a weL plasLer casL ls moved and Lurned Lhe casL ls handled wlLh Lhe palms
of Lhe hands Lo prevenL lndenLaLlons and resulLanL areas of pressure on Lhe skln
lor prevenLlng conLamlnaLlon by urlne or feces Lhe perlneal area of a dry long leg or body casL
ls encased ln a plasLlc proLecLlve coverlng
Check Lo ensure LhaL Lhe casL ls noL Loo LlghL and frequenLly monlLor Lhe cllenL's neurovascular
sLaLus usually every hour for Lhe flrsL 24 hours afLer appllcaLlon
mmedlaLely reporL Lo Lhe healLh care provlder any sudden lncreases ln Lhe amounL of dralnage
or change ln Lhe lnLegrlLy of Lhe casL
CAS1 CCMLCA1CnS
nfecLlon mosL ofLen resulLs from Lhe breakdown of skln under Lhe casL (pressure necrosls) f
Lhe pressure of Lhe necrosls occurs cllenL Lyplcally complalns of a very palnful hoL spoL" under
Lhe casL and Lhe casL may feel warmer ln Lhe affecLed area
ClrculaLlon lmpalrmenL and perlpheral nerve damage can resulL from consLrlcLlon of Lhe casL
8ecause of prolonged lmmoblllzaLlon a [olnL may become conLracLed usually ln flxed sLaLe of
flexlon or a degeneraLlve arLhrlLls may develop from lack of welghL bearlng whlch ls necessary
for carLllage vlablllLy
1AC1Cn
s Lhe appllcaLlon of a pulllng force Lo a parL of Lhe body Lo provlde reducLlon allgnmenL and
resL
Can also decrease muscle spasm (Lhus rellevlng paln) and prevenL or correcL deformlLy and
Llssue damage
Mechanlcal 1racLlon can elLher be
ConLlnuousas ln fracLure LreaLmenL
nLermlLLenLfor rellef of muscle spasm ln oLher Lypes of musculoskeleLal/neurologlc Lrauma
such as cervlcal nerve rooL compresslon
ClasslflcaLlon of 1racLlon
unnlng 1racLlonLhe pulllng force ls one dlrecLlon and cllenL's body acLs as counLerLracLlon
8alanced Suspenslonprovldes Lhe counLerLracLlon so LhaL pulllng force of Lhe LracLlon ls noL
alLered when Lhe bed or cllenL ls moved
1?LS Cl 1AC1Cn
1ypes and characLerlsLlcs of 1racLlon use
upper LxLremlLy 1racLlon
Sldearm skln or skeleLal LracLlon

Cverhead or 9090 LracLlon

lasLer 1racLlon

lracLures of Lhe humerus wlLh or wlLhouL
lnvolvemenL of Lhe shoulder and clavlcle
Same as above (depends on physlclan's
preference)
lracLures of Lhe wrlsL
LCWL LO1LM1? 1AC1Cn
8uck's exLenslon LracLlon



lracLures of Lhe hlp or femur preoperaLlvely
revenLlon of hlp flexlon conLracLures
Plp dlslocaLlon
ussell's 1racLlon
8alanced skln or skeleLal LracLlon
lracLures of Lhe hlp or end of Lhe femur
lracLures of Lhe femur or pelvls (aceLabulum)
SnAL CCLuMn Anu LLIC 1AC1Cn
Cervlcal halLer
Cervlcal skeleLal

elvlc 8elL

elvlc sllng

Cervlcal muscle spasms sLraln/spraln or
arLhrlLls
Cervlcal fracLures of Lhe splne
Muscle spasms
aln sLraln spraln or muscles spasms ln Lhe
lower back
elvlc fracLures oLher pelvlc ln[urles

SuCCAL MAnACLMLn1
LCLA1IL CAL
lor sLablllzlng Lhe fracLure Lhe cllenL may be placed ln LracLlon before surgery 1hls procedure
ls Lyplcal for managlng fracLured hlp when 8uck's LracLlon may be used preoperaLlvely
CLA1IL CCLuuLS
Cpen reducLlon wlLh lnLernal flxaLlon (Cl) ls a common meLhod ln reduclng and lmmoblllzlng
a fracLure When Lhls meLhod ls noL feaslble exLernal flxaLlon wlLh closed reducLlon ls used
Cl
8ecause Lhls permlLs early moblllzaLlon lL ls ofLen Lhe preferred surglcal meLhod for an older
adulL who ls suscepLlble Lo Lhe compllcaLlon of moblllLy
CLn LuuC1Cn
Allows Lhe surgeon dlrecL vlsuallzaLlon of Lhe fracLure slLe
n1LnAL lOA1Cn
uses meLal plns screws rods or prosLheses Lo lmmoblllze Lhe fracLure durlng heallng 1he
surgeon makes an lnclslon Lo galn access Lo Lhe broken bone and lmplanLs one or more devlces
LO1LnAL lOA1Cn
AfLer Lhe fracLure reducLlon Lhe physlclan makes small percuLaneous lnclslons so LhaL plns may
be lmplanLed lnLo Lhe bone All plns are selfdrllllng
LO1LnAL lOA1Cn AuIAn1ACLS Anu uSAuIAn1ACLS
AuIAn1ACLS
1here ls mlnlmal blood loss ln comparlson wlLh lnLernal flxaLlon
1he devlce allows early ambulaLlon and exerclse of Lhe affecLed body parL whlle rellevlng paln
1he devlce malnLalns allgnmenL ln closed fracLures LhaL wlll noL malnLaln poslLlon ln a casL and
sLablllzes commlnuLed fracLures LhaL requlre bone grafLlng
n open fracLures ln whlch skln and Llssue Lrauma accompanles Lhe fracLure Lhe devlce permlLs
easy access Lo Lhe wound and promoLes heallng
uSAuIAn1ACL
n1AC1 nlLC1Cncan lead Lo osLeomyellLls whlch ls dlfflculL Lo LreaL
CCuLA LO1LnAL lOA1Cn
s someLlmes used Lo LreaL new fracLures (closed commlnuLed and open fracLures wlLh bone
loss) as well as malunlon or nonunlon of fracLures L may also be used Lo LreaL congenlLal bone
deformlLles especlally ln chlldren
A clrcular exLernal flxaLlon devlce sLlmulaLes bone growLh
CS1CLA1IL CAL
rocedures for nonunlon
LLLC1CAL 8CnL S1MuLA1Cn
s based on research showlng LhaL bone has lnherenL elecLrlcal properLles LhaL are used ln
heallng 1he exacL mechanlsm of acLlon ls unknown
8CnL CAl1nC
May also replaced dlseased bone or lncrease bone Llssue for [olnL replacemenL
8CnL 8AnknC
f quallfled cllenLs undergolng LoLal hlp replacemenL may donaLe Lhelr femoral heads Lo Lhe
bank for laLer use as bone grafLs for oLher cllenLs
LCW n1LnS1? uLSLu uL1ASCunu (Lxogen Lherapy)
used for slowheallng fracLures or for new fracLures as an alLernaLlve Lo surgery ulLrasound
LreaLmenL ylelded excellenL resulLs
uuC 1PLA?
CenLral and muscle relaxanLs such as carlsoprodol (Soma) cyclobenzaprlne (llexerll)
meLhocarbamol (obaxln) may be prescrlbed for rellef of paln assoclaLed wlLh muscle spasm
n open fracLure Lhe LhreaL of LeLanus can be reduced wlLh LeLanus and dlphLherla Loxold or
LeLanus lmmunoglobulln for Lhe paLlenL who has noL been lmmunlzed
8one peneLraLlng anLlbloLlcs such as cephalosporln (eg cefazolln (kefzol Ancef)) are used
prophylacLlcally


















LlLLnCLS
O 8lack ! M and Pawks ! P (2009) MeJlcol sotqlcol ootsloq
cllolcol moooqemeot fot posltlve ootcomes 8
Lh
ed SL Louls
Mlssourl Saunders Llselver
O gnaLavlclus u u and Workman M L (2006) MeJlcol sotqlcol
ootsloq ctltlcol tblokloq fot collobototlve cote 3
Lh
ed uSA
Llselver Saunders
O McCance k L and PueLher S L (2006) 9otbopbysloloqy 1be
bloloqlc bosls fot Jlseose lo oJolt ooJ cbllJteo 3
Lh
ed uSA
Llselver Saunders
O Monahan l u eL al (2007) 9blpps meJlcol sotqlcol ootsloq
neoltb ooJ llloess petspectlves 8
Lh
ed SL Louls Mlssuorl
Mosby Llselver
O SmelLzer S and 8are 8 (2008) toooet ooJ 5oJJottbs textbook of
meJlcol sotqlcol ootsloq
Lh
ed uSA LlpplncoLL Wllllams and
Wllklns










1esL quesLlons
1o a paLlenL wlLh aLelecLasls perfuslon exceeds venLllaLlon Lherefore _________ exlsLs
a uead Space
b ShunLs
c SllenL unlL
d Cardlogenlc shock
2 Whlch of Lhe common phenomena LhaL may alLer bronchlal dlameLer whlch affecLs
alrway reslsLance Lo a paLlenL wlLh Lumor and mucus ln Lhe lungs
a CbsLrucLlon of Lhe alrway
b ConLracLlon of Lhe bronchlal smooLh muscle
c 1hlckenlng of bronchlal mucosa
d Loss of lung elasLlclLy
3 1he normal amounL of pleural fluld ln Lhe pleural space
a 23 Lo 30 ml
b 3 Lo 23 ml
c 0 Lo 20 ml
d 3 Lo 3 ml
4 1he followlng are Lhe slgns and sympLoms of pulmonary Luberculosls LOCL1
a rrlLablllLy
b nlghL SweaLs
c PemopLysls
d laLlgablllLy
3 L ls a LesL used Lo deLermlne wheLher a person has been lnfecLed wlLh 18 baclllus 1hls
ls also sLandardlzed lnLracuLaneous ln[ecLlon procedure and should be performed only
by Lhose Lralned ln lLs admlnlsLraLlon and readlng
a ManLoux MeLhod
b u LesL
c All of Lhe above
d none of Lhe above